Some children who are adopted from care may have special needs resulting from physical, mental or emotional problems or learning disabilities.

Children adopted from care will have experienced trauma and loss, even if they were adopted shortly after birth. Some may have additional needs resulting from physical, mental or emotional problems or disabilities.

When a possible match is suggested with you and a child, this is often an exciting time. It is important that you find out as much as possible about the child's health history and needs, so that if you decide to go ahead with the match, you will be as well informed as possible. Having realistic expectations will increase the chances of a successful adoption.

Your adopted child's health history

When children go into care (become 'looked after') or have a plan for adoption, the law requires a detailed assessment of their health. A report on their health should include information on:

their mother's pregnancy, their birth and early development

their birth family's medical history

their own medical history, including any experiences of abuse and neglect, and a chronological list of any immunisations, injuries and illnesses they've had

their current physical health, including vision, hearing and dental care

their mental health and behaviour, including experiences of trauma and loss

It can sometimes be difficult to get all this information. For example, birth parents may not want to share information about their child if they are unhappy with the plans being made. Sometimes they may be absent or the father may be unknown. Not having full health information can make it harder to understand a child's difficulties and to predict what will happen in the future.

However, the medical assessments that a child will have had throughout their time in care means there should be existing information on their health by the time they're adopted.

Under care planning requirements for looked-after children:

Health assessments should take place at least every six months for children aged four and under, and at least every 12 months for children aged five and over.

Where possible, birth parents should be involved as they can help to provide more detail about the child's medical and birth family medical history.

Based on the report of the child's health needs assessment, a health plan is developed, including any current arrangements for their healthcare and details of further healthcare that may be required.

Increasingly, it is accepted as good practice for the adoption agency's medical adviser to meet with the prospective adopters to discuss the child's health. This provides them with a better understanding of the child's needs, any gaps in their health information, and an opportunity to ask questions about the child's health. The medical adviser should then provide them with a written report, which documents what they have been told.

If the adoption goes ahead, a copy of the health assessment report will be sent to your child's GP as well as to you. You may want to discuss this with your GP, or ask your GP to talk to the medical adviser on your behalf. This can happen even after an adoption order has been made.

Parents of older adopted children often find post-adoption that medical appointments can be particularly difficult for the child as the subject of their adoption often arises, for example, if the doctor asks about family medical history. Anything you can do to help the appointment go smoothly, such as making sure the GP is aware of the situation in advance, will help your child feel more comfortable.

Developmental delays in adopted children

For a child who has been taken into care, the extent to which their development may be delayed can vary greatly. The delay can be physical or emotional, or both – the child may act younger than their age, or be unable to do things most children their age can do. Or the delay can relate to a specific area, such as their speech.

Developmental delays in looked-after and adopted children can be caused by the following factors:

The delays have been caused by something that happened during the mother's pregnancy, such as her alcohol or drug use. This can lead to the child being diagnosed with foetal alcohol syndrome (FAS) or a foetal alcohol spectrum disorder (FASD).

The child's environment after they are born may affect their development, such as developmental trauma caused by abuse or neglect, or both. If they are not properly cared for and stimulated, this affects the growth and development of certain areas of their brain leading to a lack of emotional development. This is often referred to as "attachment difficulties" or "attachment disorder".

Different children have different levels of resilience to delays caused by trauma in the womb or abuse and neglect after birth. They also have different capabilities to overcome this trauma and "catch up" developmentally.

It can be difficult to predict the long-term impact of these delays. This means that potential adopters need to accept there may be uncertainty around whether their adopted child will need specialist support services in the future. It takes a lot of perseverance, patience and determination from parents to help children overcome their difficulties, but post-adoption support is available.

Parenting neglected children

While some children in the care system may have been physically or sexually abused at some point in their lives, many of them are being looked after because their basic needs have been neglected. Studies show that neglect, such as being deprived of food or care, is often more damaging to the child than individual episodes of abuse.

Professor Peter Fonagy is chief executive of the Anna Freud Centre in London, which conducts research into attachment disorders and child mental health. He says: "The more dramatic reasons for children being taken into care, such as sexual or physical abuse, have in fact been shown to be less toxic experiences than long-term neglect. Yet neglect is more subtle and more likely to be overlooked by other adults in the child's life."

Both abuse and neglect can lead to psychological problems in children, including issues around trusting adults, which can take many years to overcome. Professor Fonagy explains that this is because they are in a state of "hyper vigilance". He says: "Children who have had bad experiences, particularly in care, are on high alert and don't believe anything anyone tells them because they don't trust them. They're shut off. They understand what they're being told but won't bring it into their own world as a truth, and they can't modify their own belief that they are not loved or that they are 'bad'."

Eating anxieties in children who have been adopted

Looked-after and adopted children often have food anxieties linked to their early experiences.

These include:

overeating

hoarding food

stealing food

problems eating certain foods, such as solids and specific textures

For example, if a child has experienced not being fed enough or regularly, this could lead to them overeating or hoarding food even after they have been placed with their adoptive family. This is because they may not fully trust that another meal will come.

Caroline Archer, author and adoptive parent of four children, has the following advice:

Keep mealtimes as low-key as possible and set regular meal routines.

Provide small amounts of the things your child enjoys and slowly introduce new tastes and textures.

Never demand they eat up or finish anything – but let them know you expect them to try.

Watch out for foods that seem to be a trigger for memories of early traumas.

Many children will also have needs relating to trauma due to neglect or abuse, in addition to their physical or medical difficulties.

Additionally, some children may have a vulnerability to some psychological conditions, such as depression or anxiety, which can be inherited. Rarer conditions that may emerge in adolescence or later, such as psychotic illnesses, may also have a genetic risk factor.